February 2012 January 2012
Press Release: HHS Announces Intent to
Delay ICD-10 Compliance Date As part of President Obama’s commitment to reducing regulatory burden, Health and Human Services Secretary Kathleen G. Sebelius announced that HHS will initiate a process to postpone the date by which certain health care entities have to comply with International Classification of Diseases, 10th Edition diagnosis and procedure codes (ICD-10). The final rule adopting ICD-10 as a standard was published in January 2009 and set a compliance date of October 1, 2013 – a delay of two years from the compliance date initially specified in the 2008 proposed rule. HHS will announce a new compliance date moving forward.
OIG Alerts Physicians to Use Heightened Scrutiny of Entities Prior to Reassigning Their Medicare Payments because they may be liable for false claims submitted by entities to which they reassigned their Medicare benefits. Physicians should carefully evaluate these entities and ensure that they are legitimate providers or suppliers of health care items and services.
Providers experiencing denials for non-ADI accreditation will see remark code N290 on their remittance advice for claims submitted for or including the technical component of an ADI procedure. More information on the ADI accreditation requirements and procedures MLN Matters® Article SE1122
On February 16, CMS released a national provider comparative billing report (CBR) addressing advanced diagnostic imaging. CBRs contain actual data-driven tables and graphs with an explanation of findings that compare a provider’s billing and payment patterns to those of their peers located in their state and across the nation. This link provides more information or you can call the SafeGuard Services’ Provider Help Desk, CBR Support Team at 530-896-7080. 1
Payment Adjustments for Unsuccessful Electronic Prescribers during the time frame of January 1, 2011, to June 30, 2011 that did not submit a hardship exemption request on or before November 8, 2011, may be subject to a 1% payment reduction on their Medicare physician fee schedule payments starting on January 1, 2012. Providers that are subjected to the payment adjustment will see remittance advice remark code N545 on all claims affected by the adjustment. Change Request (CR) 7688 is policy that implements a standard “immediate recoupment�
avoid interest
process that gives providers the option to from accruing on claims overpayments when the debt is recouped in full prior to or by the 30th day from the initial demand letter date.
2012 Clinical Diagnostic Laboratory Fee Schedule, effective January 1, 2012, is now available and can be found at this link.
EPs have until February 29, 2012, to actually register and attest to meeting meaningful use to receive an incentive payment for CY 2011 through the Medicare & Medicaid EHR Incentive Program Registration and Attestation System. Medicare EHR incentive payments to EPs are based on 75% of the Part B allowed charges for covered professional services furnished by the EP during the entire payment year. If the EP did not meet the $24,000 threshold in Part B allowed charges by the end of calendar year 2011, CMS expects to issue an incentive payment for the EP in April 2012 for 75% of the EP's Part B charges from 2011. Want more information about the EHR Incentive Programs? Make sure to visit the EHR Incentive Programs website for the latest news and updates on the EHR Incentive Programs.
Any provider attesting to receive an EHR incentive payment for either the Medicare EHR Incentive Program or the Medicaid EHR Incentive Program may potentially be subject to an audit. More information ABN Mandatory Use Date: January 1, 2012 All ABNs with the release date of March 2008 that are used after January 1, 2012, will be considered invalid. Here is the newest version of the ABN and the instructions on appropriate use.
The CMS listserv about the Medicare and Medicaid Electronic Health Record (EHR) Incentive Programs will provide timely, authoritative information about the programs, including registration and attestation updates, and details about the payment process. Subscribe to CMS EHR Incentive Programs Listserv to learn more.
FREE- Video slideshow presentations from National Provider Calls regarding PQRS, ICD10, Physician Feedback Programs, etc., are available on the CMS YouTube Channel. These video slideshows include the call slide presentation and audio with captions; each call includes presentations by CMS subject matter experts, followed by a question and answer session. 2
HIPAA Version 5010 Upgrade To help with this transition, CMS has developed a
Medicare Quarterly Provider Compliance Newsletter January 2012
number of resources available on the CMS ICD-10 website. These resources include: • •
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Fact sheets: Ensuring a Smooth Transition to Version 5010, ICD-10 Transition: An Introduction, ICD-10 Basics for Medical Practices, ICD-10 FAQS, and Talking to Your Vendors About the Transition to ICD-10. Implementation widget, which outline the steps to take to ensure compliance with Version 5010 and ICD-10, available in a widget format. CMS encourages you to download or share the widget and take advantage of printer-friendly versions of the timelines available for small provider practices, large provider practices, payers, and vendors. Timelines: Printer-friendly checklists that complement the widget, which are available for small providers, large providers, payers, and vendors.
Please visit the ICD-10 website for the latest news and resources to help you prepare, and to download and share the implementation widget today!
CGS Bulletin February 2012
TrailBlazer eBulletin January 2012
ICD-10-CM 2012 Official Guidelines for Coding and Reporting
Trailblazer is requesting that providers return the original yellow demand letter and the list of overpaid claim(s) that is included with the demand letter when refunding a demanded overpayment. More information
Narrative changes appear in bold text. Items underlined have been moved within the guidelines since the 2011 version. Italics are used to indicate revisions to heading changes.
Comprehensive Error Rate Testing (CERT) Program errors related to
This fact sheet describes common
Evaluation and Management (E/M) services and provides information on the documentation needed to support a claim submitted to Medicare for E/M services.
New and Revised Products Available from Medicare “Items and Services That Are Not Covered Under the Medicare Program” Booklet
Medicare Coverage of Radiology and Other Diagnostic Services Factsheet
“Medicare Claim Submission Guidelines” Fact Sheet Now Available in Hardcopy
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PROVIDER COMPLIANCE MEDICARE LEARNING NETWORK® (MLN) PRODUCTS The Medicare Learning Network® (MLN) products were developed in an effort to help Medicare Fee-For-Service (FFS) Providers avoid improper activities when dealing with the Medicare Program. This list will be updated as related products are developed and revised.
2011 Top Management and Performance Challenges Annually, the Office of Inspector General (OIG) prepares a summary of the most significant management and performance challenges facing the Department of Health and Human Services (HHS).
EmPower Magazine: A Resource for Every Patient Are you looking for an engaging, fun way to educate your patients about endocrine disorders? Well, EmPower Magazine is a great resource with educational, easy-toread articles written by endocrinologists! Currently, there are 11 issues of EmPower Magazine that address multiple topics including diabetes, thyroid dysfunction, osteoporosis and more. All issues of EmPower Magazine can be found online at http://empoweryourhealth.org /empower-magazine. If you would like to receive physical copies of EmPower Magazine, please contact Laura Townsend at ltownsend@aace.com with the quantity you would like to receive.
Free Videos How to Report Fraud to the OIG How to disclose and resolve potential fraud issues identified by your compliance program by using OIG’s Self-Disclosure Protocol
If your thyroid isn’t working properly, neither are you! Thyroid Awareness and the blue paisley ribbon are year-round initiatives! www.ThyroidAwareness.com is a wonderful resource for your patients and the public at large. Blue paisley merchandise will also be available throughout the year in our online store. Please continue to use these resources as we strive for the ultimate goal – that all cases of thyroid dysfunction be properly diagnosed and treated. 4
Medical Coding & Practice Management 2012 Educational Opportunities These courses are designed for physicians, non physician practitioners, coders, and billers.
Fundamentals & Advanced Endocrine Coding Course With AACE-sponsored Certified Endocrine Coder (AACE-CEC) Exam
March 16-17 - New Orleans November 9-10 - Philadelphia Cost: $550 for both courses if registration and payment made in full by February 25 Individual course pricing available OBJECTIVES • • • • • • •
Provide education on principles of medical record documentation and procedural coding ® Summarize structure and formats in ICD-9-CM, CPT and HCPCS manuals ® Apply conventions and appropriate selection of ICD-9-CM, CPT and modifiers ® Distinguish between various categories and documentation requirements for E/M CPT codes Provide education on proper use of modifiers and other common procedures performed by endocrinologists Examine guidelines set forth by the Recovery Audit Contractors (RACs), Comprehensive Error Rate Testing (CERT) Contractor and the Office of the Inspector General (OIG) Analyze relationships that may be beneficial in negotiating provider contracts and review proven business tactics in an endocrine practice
Certified Endocrine Coder Information Certified Endocrine Coder Renewal Guidelines Renewal Application
Register Now
Bridge the Gaps in Endocrine Coding th
July 11 - Atlanta
Cost: $350
OBJECTIVES • Interpret coding concepts for common endocrinology services and procedures • Discuss incident to guidelines and provisions for appropriate coding and documentation • Demonstrate knowledge of regulations and guidelines set by CMS and other regulatory agencies • Provide information on principles of medical record documentation and procedural coding
Register Now
All courses are subject to change. For more information see https://www.aace.com/coding/courses-and-webinars or contact Vanessa Lankford vlankford@aace.com 904-353-7878
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Educational Opportunities Webinar: ICD-10 Diagnosis Coding for Endocrinology Date: Thursday, March 15 Time: 12 noon to 1:30 p.m. Central Time Cost: $199 *Use Promotional Code AACE when registering here OBJECTIVES • • • •
Summarize the new ICD-10 system Discuss what documentation changes are in store Discuss the 5 types of diabetes that have assigned ICD-10 diagnosis codes Analyze examples and crosswalks for ICD-10
For more information or to register contact Paige Moskaitis at 800-259-5562 x242 or pmoskaitis@pmiMD.com
Distance Learning and Total Access with PMI® • •
Live weekly webinars each month. 24-hour Access to more than 80 topics with over 100 hours of pre-recorded training. Topics include: Transforming the Front Desk Staff ICD-10 Prep: Anatomy & Medical Terminology Compliance is NOT an Option Revenue Cycle Management for Medical Practices HIPAA Compliance Analyzing Managed Care Contracts Billing for Non Physician Practitioners Budgeting and Cash Flow
PMI National Certifications Via Webinar: Certified Medical Insurance Specialist $999 (Begins March 2) Certified Medical Coder $1,250 (Begins March 3) Certified Medical Compliance Officer $2,095 (Begins March 5) Certified Medical Office Manager $999 (Begins April 5) *Use Promotional Code AACE when registering For more information or to register contact Paige Moskaitis at 800-259-5562 x242 or pmoskaitis@pmiMD.com
AACE assumes no liability for the purchase(s) of these programs. All purchases and communications are between the attendee and the company. 6
Calculating the History Element for E/M Codes Based on 1995 Guidelines
ALL ENCOUNTERS REQUIRE A CHIEF COMPLAINT (CC)!! Each element (HPI, ROS, and PFSH) must be met or exceeded. The history component will be determined by the A CC is a concise lowest element met. statement that describes the symptom, problem, condition, diagnosis, or reason for the patient encounter. The CC is usually stated in the patient’s own words.
The HPI (History of presenting illness) is a chronological description of the development of the patient’s present illness from the first sign and/or symptom or from the previous encounter to the present. Elements of HPI are listed below. Joan Smith 2/12/71 Patient Number Date of Service: xx/xx/xxxx Cc: throat/neck hurts
Established
Duration Location
Quality
Severity
Ms. Smith is here today complaining of her neck being sore. It has gotten worse since Saturday and seems to most painful in the mornings. A heating pad helps but it is still hard to swallow. Timing Modifying Factors
Problem Focused Elements
HPI
Brief (1-3)
Expanded Problem Focused Brief (1-3)
Associated Signs/symptoms
Detailed
Comprehensive
Extended (at least 4)
Extended (at least 4)
Two types of HPI: Brief- must document one to three HPI elements Extended- must document at least four HPI elements
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The ROS is the subjective point of view from the patient. It helps identify signs and symptoms the patient is or was experiencing.
Constitution ENMT Eyes
There has been a slight decrease in her weight from the last visit, but does not complain of fever. She does not have any ear pain, mouth sores, rhino rhea, vomiting, diarrhea, blurred vision, or neck trauma. Ms. Smith has also noticed diaphoresis and some hair loss and skin sensitivity over the area where her neck is sore. Endocrine
Integumentary
Problem Focused Elements
HPI
Brief (1-3)
ROS
n/a
Expanded Problem Focused Brief (1-3) Problem pertinent (1)
Gastrointestinal
Detailed
Comprehensive
Extended (at least 4)
Extended (at least 4)
Extended (2-9)
Complete (10+)
Three types of ROS: Problem Pertinent- ask questions about the system directly related to the indentified problem in the HPI Extended- (same as above) and a limited number of 2-9 additional systems Complete- (same as above) plus all additional 10 body systems
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PFSH (past family and social history) includes previous medical illnesses, injuries, hospitalizations, current meds, family health status or cause of death in parents, siblings or children, martial status, current or past employment, developmental, school or occupational information, alcohol and/or tobacco, sexual history, or other relevant social factors.
Ms. Smith is a retired registered nurse who was recently diagnosed with diabetes type 2 but has it under control. Her mother had hypothyroidism. She has never smoked and uses alcohol socially. She has no known allergies.
Problem Focused Elements
HPI
Brief (1-3)
ROS
n/a
PFSH
n/a
Expanded Problem Focused Brief (1-3) Problem pertinent (1)
n/a
Detailed
Comprehensive
Extended (at least 4)
Extended (at least 4)
Extended (2-9)
Complete (10+)
Pertinent (1)
Complete (3 if new setting or 2 if established patient)
Two types of PFSH: ď ś Pertinent- a review of the history areas that directly relates to the problem identified in the HPI ď ś Complete- a review of two or all three history areas
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The Level of History is DETAILED.
Remember- Each element must be MET or EXCEEDED.
The HPI exceeded problem focused, expanded problem focused and detailed. It met the comprehensive requirements. The ROS exceeded problem focused, expanded problem focused and met the detailed requirements. The PFSH exceeded problem focused, expanded problem focused, and detailed. It met the comprehensive requirements. Each element met or exceeded the detailed requirement; therefore the level of History is DETAILED.
Problem Focused
Key Components
Expanded Problem Focused
Detailed
Comprehensive
x
History Exam MDM 99211 (May not Established Patient Level
require presence of physician. Usually, problem(s) minimal. Typically 5 min are spent performing or supervising these services)
99212
99213
99214
99215
Next month we will discuss the EXAM component. 10
Coding TRAC Tips on Reimbursement And Coding
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Avoid Processing Delays: When you request a redetermination (1st appeal level) of an overpayment demand notification, it is important that you include a copy of the notification letter with your request. Please share with billing staff.
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Should you receive a request for a signature or attestation because the documentation submitted did not meet the signature requirements you MUST respond within 20 days of the request.
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What is the difference between the NCCI (National Correct Coding Initiative) Column 1/Column 2 code pair edits and Mutually Exclusive Edits? Column1/Column 2 coding edits identify code pairs where one code (Column 2 code) is an integral part of the other code (Column 1 code). Mutually Exclusive coding edits identify code pairs that based on the code definitions or anatomic considerations, cannot reasonably be performed together. More information
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Documentation requirements for 99211 per Trailblazer, a Medicare Administrative Contractor
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Continuing educational activities about quality measures can help healthcare providers gain new knowledge to improve the quality of care they provide to their patients. CMS provides continuing educational opportunities that are accredited by the Accreditation Council for Continuing Medical Education (ACCME). These opportunities help to foster learning and competence and provide Continuing Medical Education (CME) credit. On this page, you will find CME activities related to quality measurement.
o Is Endonomics valuable and useful for your office? o What other topics would you like to see offered in Endonomics? o Other comments…
AACE's Socioeconomic and Member Advocacy Department's goal is to reach out to the endocrinology business world and become the onestop- shop, not only for endocrinology clinicians, but their support staff as well. Currently, Endonomics is a free newsletter for both members and non members. Interested parties should send an e-mail to Endonomics@aace.com with their name, phone and fax numbers, location and preferred e-mail address to be added to our Practice Support Network database.
All medical coding must be supported with documentation and medical necessity. **While this document represents our best efforts to provide accurate information and useful advice, we cannot guarantee that third-party payers will recognize and accept the coding and documentation ® ® recommendations. As CPT , ICD-9-CM and HCPCS codes change annually, you should reference the current CPT , ICD-9-CM and HCPCS manuals and follow the "Documentation Guidelines for Evaluation and Management Services" for the most detailed and up-to-date information. This information is taken from publicly available sources. The American Association of Clinical Endocrinologists cannot guarantee reimbursement for services as an outcome of the information and/or data used and disclaims any responsibility for denial of reimbursement. This information is intended for informational purposes only and should not be deemed as legal advice, which should be © obtained from competent local counsel. Current Procedural Terminology (CPT ) is copyright and trademark of the 2010 American Medical © Association (AMA). All Rights Reserved. No fee schedules, basic units, relative values, or related listings are included in CPT . The AMA assumes no liability for the data contained herein. Applicable FARS/DFARS restrictions apply to government use.
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